高压氧预处理对冠状动脉旁路移植手术的心肌保护作用

Myocardium protective effects of repeated hyperbaric oxygen preconditioning in patients undergoing coronary artery bypass graft surgery

目的:评估重复高压氧(HBO)预处理对冠状动脉旁路移植(CABG)手术患者的心肌保护效果及临床应用安全性。方法:49例拟行择期CABG手术的患者,随机分为对照组(n=25)和预处理组(n=24),对照组包括15例采用体外循环(CPB)手术(On-pump)方式和10例不停跳手术(Off-pump)方式的患者,预处理组CPB手术和Off-pump手术患者分别为14例和10例。预处理组患者于手术前5 d开始给予HBO预处理措施(2.0 ATA,120 min/次,1次/d,连续5 d),对照组不给予HBO预处理。于诱导前、到达ICU、术后6、12、24、48及72 h抽取桡动脉血检测血清肌钙蛋白I(cTnI)浓度,并计算从到达ICU至术后6、12、24和48 h的心血管支持药物用量评分。结果:两组患者术前一般资料组间比较均无统计学差异。对于CPB手术患者:从到达ICU至术后48 h这5个时间点,预处理组患者的血清cTnI浓度均明显低于对照组(P<0.05)。从术后24 h至36 h,预处理组心血管支持药物用量明显低于对照组(P<0.05)。对于Off-pump手术患者:从诱导前直至术后72 h,预处理组患者的血清cTnI浓度与对照组相比较没有明显差别。术后心血管支持药物用量评分两组间也无统计学差异。结论:重复HBO预处理可安全用于心脏外科CABG手术患者,减少CPB手术患者术后cTnI的释放和心血管支持药物的用量,具有心肌保护效果,但对Off-pump手术患者无明显的心肌保护效应。

AIM：To evaluate the safety and beneficial effect of repeated hyperbaric oxygen （HBO） preconditioning as an adjunctive therapy for myocardium protection in clinical trials of coronary artery bypass graft （CABG） surgery. METHODS： Forty nine patients were prospectively randomized into control group （n=25） and HBO preconditioning group （n=24） before CABG surgery. Control group included 15 patients undergoing on-pump surgery and 10 patients undergoing off-pump surgery. HBO group included 14 patients undergoing on-pump surgery and 10 patients undergoing off-pump surgery. Patients in HBO group were intermittently exposed to hyperbaric oxygen for 120 min at 2.0 ATA, once daily for 5 consecutive days before surgery. Serum troponin I （cTnI） concentration was determined, and blood samples were taken from radial artery pressure line at sevem time points, respectively, before induction of anesthesia, arrival at ICU and 6, 12, 24, 48 and 72 h after surgery. Inotrope score was calculated from the time point of ICU arrival to 48 h after surgery. RESULTS： Patient characteristics were comparable in the two groups. In patients with on-pump surgery, serum cTnI release was lower in HBO group during the time point from ICU arrival to 48 h after surgery （P〈0.05）. Inotrope score during the period from 24 to 36 h after surgery was lower in the HBO group compared with that in control group （P〈0.05）. However, serum cTnI concentration and inotrope score were similar in both groups in patients with off-pump surgery. CONCLUSION： A modality of repeated preconditioning with HBO is safe and well tolerated in patients undergoing CABG surgery. HBO preconditioning reduces the release of serum cTnI and inotropic drug use in on-pump CABG surgery but has only a limited protective effect on patients undergoing off-pump surgery.